Investigating the effect of age on skeletal stability after sagittal split ramus osteotomy for mandibular setback

Chung-O Lee; Hee-Don Hwang; Jin-Wook Choi; Jin-Wook Kim; Sang-Han Lee; Tae-Geon Kwon

doi:10.5125/jkaoms.2012.38.6.354

Clinical Analysis

J Korean Assoc Oral Maxillofac Surg 2012;38(6):354-359.

Published online: 31 December 2012

DOI: https://doi.org/10.5125/jkaoms.2012.38.6.354

Investigating the effect of age on skeletal stability after sagittal split ramus osteotomy for mandibular setback

Chung-O Lee, Hee-Don Hwang, Jin-Wook Choi, Jin-Wook Kim, Sang-Han Lee, Tae-Geon Kwon

Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea

Tae-Geon Kwon Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2175, Dalgubeol-daero, Jung-gu, Daegu 700-705, Korea TEL: +82-53-600-7574 FAX: +82-53-426-5365 E-mail: kwondk@knu.ac.kr

Received 9 July 2012 Revised 3 September 2012 Accepted 8 October 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The purpose of this study was to investigate whether the age factor would be related with stability of mandibular setback surgery for patients with mandibular prognathism.

Materials and Methods

We compared the relapse patterns of 47 patients divided into three age groups (termed younger, adult, and older). The younger group consisted of patients between 15 and 17 years old; the adult group was made up of patients between 21 and 23 years old, and the older group was made up of patients more than 40 years old. The positional change of B point was evaluated at preoperative, postoperative, and follow-up states.

Results

The horizontal relapse ratio was 21.7% in the younger group, 15.3% in the adult group, and 15.7% in the older group. Although relatively higher degrees of relapse were found in the younger group, this increase was not statistically significant. Spearman’s correlation analysis was performed to explore other factors contributing to relapse. We subsequently found that the amount of relapse was related to horizontal setback.

Conclusion

Although the degree of relapse in younger patients is not significant;y higher compared to other groups. The major contributing factor to relapse after sagittal split ramus osteotomy is amount of setback rather than age when the surgery was performed to patients over than 15 years of age.

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Keywords: Mandibular osteotomy, Age, Relapse, Sagittal split ramus

Fig. 1.

Lateral cephalograms were obtained before surgery (T0), 2-3 days after surgery (T1), and more than 6 months after surgery (T2).

Fig. 2.

Measurement for lateral cephalometric analysis. (N: nasion, S: sella, Po: porion, Or: orbitale, FH: frankfurt)

Fig. 3.

Comparison of surgical change (B [x]) and relapse according to the groups.

Table 1.

Demographic data of patients before the surgery

Group	Group 1 (younger group)	Group 2 (adult group)	Group 3 (older group)	P-value
Age	15-17 (16.7±0.7)	21-23 (22.0±0.7)	Over 40 (47.1±3.5)
Patients (gender)	10 (M : F=1 : 9)	30 (M : F=20 : 10)	7 (M : F=1 : 6)
SNB (T0)	82.34±3.47	82.98±4.08	82.98±4.08	0.940
FH-NB (T0)	89.94±3.53	91.25±3.19	90.47±2.00	0.535

(M: male, F: female, SNB: sella-nasion-B point angle, FH-NB: FH to nasion-B point angle)

T0 means 1 month before surgery.

Values are mean±standard deviation.

Table 2.

Horizontal mandibular position change after surgery (Kruskal-Wallis test)

		Group 1	Group 2	Group 3	P-value
1. Horizontal change of B point
	Surgical change of setback (mm at B)	8.05±3.15	10.56±2.77	9.57±2.46	0.428
	Postoperative change of relapse (mm at B)	1.75±1.08	1.61±1.20	1.50±0.77	0.875
	Degree of relapse (%)	21.74±11.84	15.25±11.69	15.67±6.94	0.699
2. Angular change of SNB
	Preoperative degree of SNB	82.34±3.47	82.98±4.08	82.98±4.08	0.940
	Surgical change of SNB	5.10±1.74	5.04±1.42	5.41±2.75	0.938
	Postoperative change of SNB	1.20±0.73	0.73±0.62	0.94±0.59	0.140
	Degree of relapse (%)	23.53±13.12	14.48±13.88	17.38±13.38	0.280
3. Angular change of FH-NB
	Preoperative degree of FH-NB	89.94±3.53	91.25±3.19	90.47±2.00	0.535
	Surgical change of FH-NB	4.93±1.86	5.00±1.41	5.21±1.21	0.938
	Postoperative change of FH-NB	1.07±0.82	0.76±0.67	0.82±0.47	0.597
	Degree of relapse (%)	21.70±14.37	15.20±13.93	15.74±7.13	0.451

(SNB: sella-nasion-B point angle, FH-NB: FH to nasion-B point angle)

Values are mean±standard deviation.

Table 3.

Result of Spearman's correlation analysis

Correlation analysis	Preoperative condition (T0)		Postoperative change (T0-T1)			Age
Correlation analysis	SNB (T0)	FH-NB (T0)	ΔB (x) (T0-T1)	ΔSNB (T0-T1)	ΔFH-NB (T0-T1)	Age
ΔB (x) (T1-T2)	r=0.119	r=0.053	r=0.365	r=0.291	r=0.276	r=-0.079
ΔB (x) (T1-T2)	P=0.901	P=0.726	P=0.012	P=0.047	P=0.000	P=0.596

(SNB: sella-nasion-B point angle, FH-NB: FH to nasion-B point angle, SNB (T0): SNB degree at preoperative state, FH-NB (T0): FH-NB degree at preoperative state, ΔB (x) (T0-T1): amount of surgical change at B point, ΔSNB (T0-T1): change of SNB degree between preoperative and postoperative states, ΔFH-NB (T0-T1): change of FH-NB degree between preoperative and postoperative states, ΔB (x) (T1-T2): amount of horizontal relapse at B point)

Table 4.

Comparison of relapse degree by fixation method after SSRO

Study	Fixation method	Patients (n)	Follow-up	Mean setback (mm)	Relapse (mm), %
Choi et al. [4] (Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2000)	RIF	71	2 years	7.8	0.9 (Pg), 11.5
	Semi-rigid	15	2 years	8.2	1.1 (Pg), 13.4
Harada and Enomoto [5] (J Oral Maxillofac Surg, 1997)	RIF	10	12 months	6.7	0.94 (B), 14.0
Harada and Enomoto [5] (J Oral Maxillofac Surg, 1997)	Semi-rigid	10	12 months	6.6	1.05 (Pg), 15.7

(SSRO: sagittal split ramus osteotomy, RIF: rigid internal fixation, Reference points Pg: pogonion, B: B point)

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